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cognitive impairment

Impairment of cognition. Loss of cognitive function in at least on domain: memory, lanuguage, executive function, visuospatial function or behavior. Also see cognition, altered mental status, encephalopathy. Classification: - dementia - delirium - psychosis Etiology: === acute/subacute === 1) vascular: stroke 2) CNS infections: viral encephalitis 3) toxic: acute drug effect (amitriptyline) 4) metabolic: hepatic encephalopathy 5) inflammatory: cerebral vasculitis 6) nutritional: Wernicke-Korsakoff syndrome (thiamine deficiency) 7) degenerative: a) delirium superimposed on dementia b) urinary tract infection 8) epileptic: seizure, postictal state 9) traumatic: acute head injury 10) psychiatric: acute psychosis (schizophrenia) 11) neoplastic: primary brain tumor (obstructive hydrocephalus) === chronic === 1) vascular disease - ischemic stroke, lacunar infarct - leukoaraiosis - cerebral amyloid angiopathy - primary CNS angiitis - blood-brain barrier breakdown (BBB) is an early marker of cognitive dysfunction in humans independent of beta-amyloid & MAP-tau [11] 2) infectious: - HIV, AIDS dementia complex, possibly latent CMV - neurosyphilis - transmissible spongiform encephalopathy - Creutzfeldt-Jakob disease - fungal meningitis - composite measure of exposure to Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, & Herpes simplex HSV1 & HSV2 is a risk factor [8] 3) toxic: a) chronic drug effect (lithium carbonate) b) heavy drinking in middle-age men [10] c) lead poisoning (plumbism) 4) metabolic: hypothyroidism, diabetes mellitus in poor control 5) inflammatory: autoimmune meningoencephalitis 6) nutritional: - vitamin B12 deficiency - consumption of ultra-processed foods [16] 7) degenerative: a) Alzheimer's disease b) diffuse Lewy body disease c) frontotemporal dementia d) other neurodegenerative diseases 8) epileptic: psychomotor status epilepticus 9) traumatic: sequellae of brain trauma 10) psychiatric: chronic psychosis (bipolar disorder) 11) depression in early adulthood may increase risk for cognitive impairment in midlife [17] 12) obstructive sleep apnea may cause cognitive impairment in midlife [18] 13) neoplastic: meningeal carcinomatosis (communicating hydrocephalus) [1] 14) chronic renal insufficiency [6] 15) hearing loss, especially if accompanied by visual impairment [15] Epidemiology: - up to 30% of community-dwelling adults - no specific cause found in 24% [14] Clinical manifestations: - cognitive decline is already evident in middle age (age 45-49) [2] - functional limitations due to cognitive decline are more common among adults with vision impairment (RR=3) [12] Radiology: - neuroimaging (all patients) - MRI neuroimaging or non-contrast CT of brain [1] Differential diagnosis: - depression - anxiety - ADHD - chronic fatigue syndrome - fibromyalgia - poor sleep hygiene [14] Management: 1) no evidence support the use of dietary supplements or pharmaceuticals to prevent cognitive decline [3] 2) exercise improves cognition in the elderly [4] 3) Mediterranean diet in combination with exercise, reduces risk of cognitive impairment & dementia [5] 4) low saturated fat intake & high monounsaturated fat intake are beneficial for cognition in elderly women [7] 5) USPSTF recommends against routine screening of elderly - no evidence of improved outcomes [9] 6) prognosis: - most younger patients with cognitive impairment do not deteriotate [14]

Interactions

disease interactions

Related

cognition (intelligence) cognitive assessment differential diagnosis of cognitive impairment encephalopathy intellectual disability; mental retardation prevention of cognitive impairment

Specific

cognitive impairment in the elderly critical illness cognitive impairment (post-ICU cognitive impairment) dementia; Alzheimer's disease & related dementias (ADRD) executive function impairment in Alzheimer's disease lack of awareness language impairment in Alzheimer's disease learning impairment memory impairment post-chemotherapy cognitive impairment postoperative cognitive impairment pre-mild cognitive impairment (preMCI)

General

impairment mental disorder sign/symptom

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 18. American College of Physicians, Philadelphia 2009, 2012, 2018.
  2. Singh-Manoux A et al. Timing of onset of cognitive decline: Results from Whitehall II prospective cohort study. BMJ 2012 Jan 5; 344:d7622. PMID: 22223828
  3. Plassman BL, Williams JW Jr, Burke JR, et al. Systematic review: Factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med Aug 3, 2010; 153(3):182-193 PMID: 20547887
  4. Jackson AS, Sui X, Hebert JR, et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 2009; 169(19):1781-1787 PMID: 19858436
  5. Scarmeas N et al Physical Activity, Diet, and Risk of Alzheimer Disease JAMA. 2009;302(6):627-637. PMID: 19671904 http://jama.ama-assn.org/cgi/content/full/302/6/627 - Feart C et al Adherence to a Mediterranean Diet, Cognitive Decline, and Risk of Dementia JAMA. 2009;302(6):638-648. PMID: 19671905 http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe - Knopman DS et al Mediterranean Diet and Late-Life Cognitive Impairment A Taste of Benefit JAMA. 2009;302(6):686-687 PMID: 19671912 http://mail.google.com/mail/?hl=en&tab=wm#inbox/1230e5270aa617fe
  6. Yaffe K, Ackerson L, Kurella Tamura M, et al. Chronic kidney disease and cognitive function in older adults: findings from the chronic renal insufficiency cohort cognitive study. J Am Geriatr Soc 2010 Feb; 58(2):338-345. Epub 2010 Jan 26. PMID: 20374407
  7. Okereke OI et al. Dietary fat types and 4-year cognitive change in community- dwelling older women. Ann Neurol 2012 May 17 PMID: 22605573 http://onlinelibrary.wiley.com/doi/10.1002/ana.23593/abstract;jsessionid=93500A913F6A8B59C680984086D4CD7B.d01t03
  8. Katan M et al Infectious burden and cognitive function. The Northern Manhattan Study. Neurology March 26, 2013 vol. 80 no. 13 1209-1215 PMID: 23530151 http://www.neurology.org/content/80/13/1209.short - Strandberg TE and Alello AE Is the microbe-dementia hypothesis finally ready for a treatment trial? Neurology March 26, 2013 vol. 80 no. 13 1182-1183 PMID: 23530150 http://www.neurology.org/content/80/13/1182.extract - Prasad KM et al Progressive gray matter loss and changes in cognitive functioning associated with exposure to herpes simplex virus 1 in schizophrenia: A longitudinal study. Am J Psychiatry 2011 Jun 1; PMID: 21632649
  9. Lin JS et al Screening for Cognitive Impairment in Older Adults: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 22 October 2013 PMID: 24145578 http://annals.org/article.aspx?articleid=1760977 - Moyer VA et al Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 25 March 2014 PMID: 24663815 http://annals.org/article.aspx?articleid=1850963
  10. Sabia S et al Alcohol consumption and cognitive decline in early old age. Neurology. January 15, 2014 PMID: 24431298 http://www.neurology.org/content/early/2014/01/15/WNL.0000000000000063
  11. Nation DA, Sweeney MD, Montagne A et al Blood-brain barrier breakdown is an early biomarker of human cognitive dysfunction. Nature Medicine 2019. Jan 14. PMID: 30643288 https://www.nature.com/articles/s41591-018-0297-y
  12. Saydah S, Gerzoff RB, Taylor CA, Ehrlich JR, Saaddine J. Vision Impairment and Subjective Cognitive Decline-Related Functional Limitations - United States, 2015-2017. MMWR Morb Mortal Wkly Rep 2019;68:453-457 https://www.cdc.gov/mmwr/volumes/68/wr/mm6820a2.htm
  13. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  14. McWhirter L, Ritchie C, Stone J, Carson A. Functional cognitive disorders: A systematic review. Lancet Psychiatry 2019 Nov 12; PMID: 31732482 https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30405-5/fulltext
  15. Ge S et al. Longitudinal association between hearing loss, vision loss, dual sensory loss, and cognitive decline. J Am Geriatr Soc 2021 Mar; 69:644. PMID: 33258497 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16933
  16. Gomes Goncalves N, Vidal Ferreira N, Khandpur N et al JAMA Neurol. 2022 Dec 5. Association Between Consumption of Ultraprocessed Foods and Cognitive Decline. PMID: 36469335 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799140
  17. Dintica CS, Habes M, Erus G et al Long-term depressive symptoms and midlife brain age. J Affect Disord. 2023 Jan 1;320:436-441 PMID: 36202300 https://www.sciencedirect.com/science/article/abs/pii/S0165032722011788
  18. Gnoni V, Mesquita M, O'Regan D et al Distinct cognitive changes in male patients with obstructive sleep apnoea without co-morbidities. Front. Sleep, 06 April 2023 https://www.frontiersin.org/articles/10.3389/frsle.2023.1097946/full